Monday, December 29, 2014


The first sign of trouble is when the nurse says she needs you in the room NOW.  The second was when I came bedside and saw a scared middle-aged man.  There’s different kinds of scared.  There’s anxious scared.  There’s uncomfortable scared.  There’s “what are you going to do to me?” scared.  And then there’s the “I’m going to die right now and there’s not a damn thing you can do about it” scared.  That was him.

One of the problems about medical writing in the era of patient privacy is that if I tell you too much about the case, someone can figure out who it was.  But here’s what I think I can tell you.  He had overcome significant medical issues to live a happy and productive life, graduating from college, spending time with family, working until his condition no longer allowed him to do so.  And I can tell you he was scared, and he was dying, and he knew it.  So did I, and everyone else in that room.  You don’t come in the slightly off-white color of grade school paste and leave standing.

Over the course of an hour, we tried to figure out why.  Infection?  Nothing obvious at first glance.  Internal bleeding?  Nope.  He kept going downhill, his breathing more labored and his blood pressure falling, until I said, “I think we need to put you to sleep and put in a tube into your throat to make sure you get enough oxygen.  Is that okay with you?”
He nodded.  Scared.  Me too.  I told him we do this a lot, that we’d keep him asleep to make sure he didn’t have any pain, and we’d get him over this.  He nodded.  Scared.  Me too.

I put him to sleep and the procedure went fine.  He started to move after the initial medications wore off, clearly in pain, and for a brief few moments he looked at me, around the room, back to me.  Then, mercifully, the meds kicked back in again, and he was responsive no more.  Or ever again.

Eventually, we found out why he died.  And there was nothing that anyone could have done to stop it.  A long valiant fight had been lost in the same way we’ll all eventually lose.  I sometimes make myself feel better by thinking that in our business, if you even save 1 out of 10, you’re still batting .100 against God, the greatest pitcher there ever was.  Not a bad average in the long run.

Do you want to know what haunts a seen-everything, done-it-all, been-doing-this-far-to-long ER doc? It’s lying to a patient who’s scared to die, and that the last thing they saw before they went to  their forever sleep was your face, and the last thing they heard were your words.  Lying.  And they knew it.

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